health systems ask ‘what matters’ IN ORDER to put patient’s perspective first

There are more than 46 million Americans age 65 and over, and that number is projected to double to more than 98 million by 2060, according to researchers. For many, it is nice to think about how many years Americans are living today. But today’s senior citizen also is focused on quality of life, not just the quantity of years.

It is important to recognize many older adults have more than one chronic disease and have been prescribed multiple medications (often ordered by a variety of physicians). And many individuals in this population live with uncertainty as they transition from living independently to reliance on others. It can be a complicated time once they are hospitalized.

One initiative hoping to make a difference is the “Age-Friendly Health Systems” approach to healthcare. This move comes from the John A. Hartford Foundation and the Institute for Healthcare Improvement (IHI). They have joined in partnership with the American Hospital Association (AHA) and the Catholic Health Association of the United States (CHA).

As of July 21 of last year, 779 health care organizations have earned either level 1 (Participant) recognition in the [Age-Friendly] movement, according to the IHI.

In the Atlanta metro area, several facilities have implemented the program, including Grady’s ER, Emory’s Integrated Memory Clinic and the Veterans Health Administration (VA) facility.

“Putting the patient’s perspective first, asking what matters, is one of the most critical aspects of following 4M Age-Friendly Health System framework,” said Dr. Rina Eisenstein, Chief of the Bronze Out-patient [geriatric] Clinic, which employs the system that often is called simply “4M.”

“The 4M framework of knowing what matters to a unique individual, putting patient’s preferences first, and addressing them in the evidence-based manner will not only improve care and patient outcomes, it could also improve professional satisfaction in caring for older patient,” Eisenstein said.

“Perhaps the patient prefers to be made comfortable and remain home as opposed to having multiple tests requiring him to leave the house creating vulnerability during the pandemic,” she says. “During this era of COVID-19, when family members cannot accompany the patient or be at the hospital bedside, making home arrangements might be essential.”

The 4M system is based on an evidencebased framework that plays an integral role in maintaining an agefriendly system. The name comes from the four “M’s” in the system’s guidelines as healthcare workers

■ Determine what Matters to older adults;

■ Make sure Medications are helpful, not harmful to patients;

■ Attend to Mentation, including delirium, depression, and dementia; and

■ Ensure Mobility, so older Adults can maintain their function.

Age-Friendly Health can extend beyond the hospital. For example, your physicians’ medical practice may incorporate these strategies, as well:

■ What Matters to Seniors: knowing and aligning care with each older adult’s specific health outcome goals and care preferences including, but not limited to, end-of-life care, and across settings of care.

■ Medication: if medication is necessary, using age-friendly medication that does not interfere with what matters to the older adult, Mobility, or Mentation across settings of care.

■ Mentation: preventing, identifying, treating, and managing delirium across settings of care.

What COVID-19 Is Teaching Us About Seniors

In a recent Journal of Geriatric Emergency Medicine article, there are excellent updates for emergency room providers. “COVID-19 has taught us, once again, that acute illness may happen at any time, regardless of underlying conditions or risks,” state the authors.

“Inoculation of all older adults will take time and we’re facing a long winter in which social distancing and isolation will be the norm,” says Terry Fulmer, PhD, RN, FAAN, President, The John A. Hartford Foundation.

In a December 2020 article, Fulmer says, “Health systems must learn from their experiences with COVID-19 thus far, prioritize age-friendly care and support champions of this movement in all departments, not just COVID-19 hot spots like the ICU.

Current research is showing there are specific problems with COVID-19 and older adults, making the age-friendly process more important than ever:

■ More than 42% of COVID-19 deaths in the U.S. have occurred in nursing homes or long-term care facilities.

■ People with mental health disorders presenting to the ED have a higher risk of COVID-19 infection than people without them.

■ Rehospitalization increases if caregivers are not involved in developing personcentered discharge plans and helping with adherence to treatment plans.

■ Mobility: ensuring that each older adult moves safely every day to maintain function and do what matters.

■ Older adults with COVID-19 infections who have multiple comorbid illnesses and underlying uncontrolled medical conditions have a higher rate of admission to the intensive care unit and a higher mortality rate.

The COVID-19 pandemic has reminded us that acute illness may happen at any time, regardless of underlying conditions or risks.

While individuals with certain underlying diagnoses such as diabetes or COPD, as well as those who are older may be at higher risk for more severe disease, younger and previously ‘healthy’ people have also become seriously ill.

Even after a year, there is still much to learn about the coronavirus and how pandemics can affect all populations.

Decline Happens

“In the last quarter of their lives, people experience a higher frequency of loss compared to other life stages, whether it’s people around them dying, a loss of their roles in society, or losses in terms of hearing, vision, mobility or function,” said Erin EmeryTiburcio, PhD, Co-Director of the Geriatric Workforce Enhancement Program of Illinois based at Rush University Medical Center.

“Almost everyone is going to experience some degree of decline and sorting out what is normal can be difficult. Psychologists are well-equipped to help with this.” In addition, the vast majority of research that’s been done on older adults now needs to be redone with the baby boomers because their generation is quite different from those who came before them,” she said.

The year 2020 and COVID-19 have played havoc with several age-friendly programs. Sadly, the pandemic is not showing any signs of slowing down. And with the senior population filling emergency rooms, serious overcrowding in the ER and hallways and staff shortages, saving as many lives as possible has taken precedence.

With a slowing of COVID-19, Age-Friendly Health Systems will begin to help today’s hospitals plan ahead. “They can redeploy and prioritize existing resources, if necessary, to serve a rapidly growing patient population,” Dr. Melinda Estes, President and CEO, Saint Luke’s Health System (and 2020 AHA board chair), states in an AHA blog.

“At some point, all of us may depend on a hospital or provider who is expertly trained in the nuances of caring for older adults. This initiative is another integral part of advancing health for everyone,” Estes said. This article was written with the support of a journalism fellowship from The Gerontological Society of America, The Journalists Network on Generations and The John A. Hartford Foundation.